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Alzheimer’s Disease

Alzheimer's disease is a chronic neurodegenerative disease that starts slowly and gets worse over time. Alzheimer's disease (AD) accounts for 60% to 70% of cases of dementia. These people have short term memory loss which is the most common early symptom.

As the disease progresses over time, symptoms may include problems with language, disorientation (including easily getting lost), mood swings and loss of motivation, not managing self-care and behavioral issues. As a person's condition declines, they often withdraw from family and society and gradually, bodily functions are lost, ultimately leading to death.

6What problems may result from each one of these areas of brain damage?

7Are there any prevention methods available?

8How can you manage Alzheimer’s disease?

The cause of Alzheimer's disease is misunderstood. The cause of Alzheimer’s is believed to be about 70% genetically related. A history of head injuries, depression or hypertension can also increase the risk of developing Alzheimer’s. It most often begins in people over 65 years of age.

Affected people increasingly rely on others for assistance as the disease progresses, often placing a burden on the caregiver; the pressures can include social, psychological, physical, and economic elements.Examination of brain tissue is needed for a definite diagnosis. In some cases the initial symptoms are often mistaken for normal ageing. There is no medication or treatment to prevent the disease, only treatments can temporarily improve the symptoms. Mental and physical exercise and also avoiding weight gain may decrease the risk of AD. Exercise programs can potentially improve outcomes and improve their daily living abilities.

Pre-dementia

The first symptoms are often mistakenly attributed to ageing or stress. These early symptoms can affect the most complex daily living activities. The most noticeable symptom is short term memory loss, as well as functions of attentiveness, planning, flexibility, and abstract thinking, or impairments in semantic memory (memory of meanings, and concept relationships). Apathy can be observed at this stage, depression, irritability and reduced awareness of subtle memory difficulties are also common. This is found to be a transitional stage between normal ageing and dementia. MCI can have a variety of symptoms, and when memory loss is the predominant symptom, it is seen as a prodromal stage of Alzheimer's disease.

Early

There is an increasing impairment of learning and memory eventually leads to a definitive diagnosis. Some cases show, difficulties with language, executive functions, perception, or execution of movements are more prominent than memory problems. Older memories of the person's life (episodic memory), facts learned (semantic memory), and implicit memory (the memory of the body on how to do things, such as using a fork to eat) are affected to a lesser degree than new facts or memories. The person with Alzheimer's is capable of communicating basic ideas adequately, and may still perform fine motor tasks such as writing, drawing or dressing, certain movement coordination and planning difficulties may be present, but they are commonly unnoticed. As the disease progresses, the person may need assistance or supervision with the most cognitively demanding activities.

Moderate

Progressive deterioration makes them unable to perform most common activities of daily living.

Speech difficulties become evident, reading and writing skills are also progressively lost. Complex motor sequences become less coordinated as time passes.

During this phase, memory problems worsen, and the person may fail to recognize close relatives, long term memory, which was previously intact, becomes impaired. Common manifestations are wandering, irritability and labile effect, leading to crying, outbursts of unpremeditated aggression, or resistance to caregiving. Some of these people become delusional to and lose insight of their disease process and limitations. Urinary incontinence can develop, which create stress for relatives and care givers, which can be reduced by moving the person from home care to other long term care facilities.

Advanced

During the final stages, the patient is completely dependent upon caregivers. Language is reduced to simple phrases or even single words, and in the end speech loss. Aggressiveness can still be present, as well as extreme apathy and exhaustion. People with Alzheimer's lose muscle mass and mobility deteriorate to the point where they are bedridden and unable to feed themselves. The cause of death is usually caused by, an infection of pressure ulcers or pneumonia, not the disease itself.

Patients that have Type 2 Diabetics and/or high blood pressure have an increased risk of developing Mild Cognitive Impairment (MCI) which is the earliest stage of dementia. About 56% of patients with Mild Cognitive Impairment (MCI) progress to Alzheimer’s disease. Studies have shown that preventing brain hypoxia (which occurs in OSA), could reduce the risk of developing Alzheimer’s disease.

Sleep apnea patients may develop shrunken brain structures which are involved in memory according called, mammillary bodies. Patients that suffer from memory loss or other conditions, such as Alzheimer’s disease, also show signs of shrunken mammillary bodies.

Studies show that cognitive impairment in older women is a risk factor in Sleep Disordered Breathing, including OSA. In an older population, one can find, even more, areas of damage as more studies are done.

The areas of brain damage are responsible for disorders including difficulties with, mood, behavior, memory, heart regulation, high blood pressure, breathing control, cognition, fear, anxiety and other depression. Damage over caused over periods of time can cause structural changes. This could improve to some degree or even resolve with treatment, but only time will tell. The development of Alzheimer’s disease could be prevented, with early treatment of OSA.

Medication Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with a reduced likelihood of developing Alzheimer’s disease. Hormone replacement therapy, although previously used, may increase the risk of dementia.

Lifestyle People who engage in such as reading, playing board games, completing crossword puzzles, playing musical instruments, or regular social interaction show a reduced risk for Alzheimer's disease. Exercise is also associated with a reduced risk of AD.

Diet People who eat healthy, have a lower risk of AD.

Medications

There is no medication that has been clearly shown to delay or halt the progression of the disease. However there may be a reduction in the activity of the cholinergic neurons is a well-known feature of Alzheimer's disease.

Psychosocial intervention

Psychological interventions are used as an alternative to pharmaceutical treatment and can be classified within behavior-, emotion-, cognition- or stimulation-oriented approaches.

Caregiving

Alzheimer's has no cure and it gradually makes people incapable of tending for their own needs, caregiving essentially is the treatment and should be carefully managed over the course of the disease. In the final stages of the disease, treatment is centered on relieving discomfort until death, often with the help of hospice.

Feeding tubes

People with Alzheimer's disease often develop problems with eating, as they find it difficult to swallow, have a reduced appetite or the inability to recognize food. The care givers and families often request they have some form of feeding tube.